Table 1

Disciplines and their support to mitigate PICC harm

DisciplineMitigate PICC harm
Vascular access teamAdvise and recommend optimal device choice per patient; preferential single-lumen PICC to reduce complication risk; ensure proper insertion and maintenance; evaluate quality processes related to line care (eg, dressing intactness, occlusion rates, phlebitis, infections, thrombosis; line de-escalation).
NursingPlay a key role in the choice of peripheral access device and line care.
 Bedside nursesEstablish competencies for placing peripheral venous catheters; adhere to the standard of intravenous line care to reduce occlusion risk (eg, avoid drawing blood from lines) and prevent infectious complications; evaluate the continued PICC need and risk; train when to escalate to the vascular access team for expertise.
Infection preventionistsProvide feedback on central line use and infectious complications; participate in development of policies and new product reviews.
PharmacistsEvaluate switch to oral medications; address the use of alteplase as a marker for occlusion; advise on vesicant and irritant infusions.
PhysiciansPlay a key role in requesting PICC line placement and also its duration of use.
 Infectious diseasesAssess the need for long-term parenteral antimicrobials versus potential oral alternatives; promote optimal device choice and discontinuation of PICC when no longer needed.
 SurgeryAssess the need for parenteral versus enteral nutrition; evaluate the optimal short-term central line to use.
 Hospitalists/internistsCare for a large number of patients; avoid ordering PICCs out of convenience (eg, for blood draws); understand the appropriate indications for use; daily evaluate device for complication risk and necessity.
 IntensivistsChoose the optimal line and place central venous catheters; daily evaluate device for complication risk and necessity; further evaluate the need for central access when ready to transfer out of intensive care.
 Physicians in trainingEvaluate on the indications for vascular device use, place central venous catheters and address discontinuation; address their competencies for placing and maintaining catheters; closely partner with bedside nurses on device necessity and risk.
 NephrologistsChampion the importance of avoiding PICC placement in patients with chronic kidney disease to reserve venous access.
 Interventional radiologistsPartner with the vascular access team on patient selection for PICC (preferably the vascular team performs the procedures preventing patient exposure to fluoroscopy); obtain reason for PICC placement; use single-lumen PICC unless otherwise requested.
Administrative leadersProvide support for an effective vascular access team; understand the adverse quality outcomes (eg, patient experience, deep venous thrombosis, infection) and financial risks (eg, hospital-acquired condition penalties) without an effective vascular access team.
  • PICC, peripherally inserted central venous catheter.